ABIM Internal Medicine Boards & ITE EXAM QUESTIONS AND
CORRECT VERIFIED SOLUTIONS LATEST UPDATE THIS YEAR –
JUST RELEASED
ABIM Internal Medicine Boards & ITE Exam – 100 MCQ Questions with Rationales
10-Line Exam Coverage in Points Form
1. Exam Structure & Logistics – 240 MCQs, four blocks up to 2 hours each (approx. 10
hours total), at Pearson VUE. ABIM certification offered once per year in August;
registration opens December through April .
2. Content Blueprint – ABIM publishes target percentages. Cardiology 14%, GI, Pulm, ID,
Endo each 9%, Rheum 8–9%, Heme/Onc 9%, Nephro 6%, Neuro/Psych each 4%, Derm
3%, Geriatrics 3%, Allergy/Immunology 2%, Ethics/Patient Safety 6%, plus other topics .
3. High-Yield Cardiology – HFrEF (ARNI, beta-blocker, MRA, SGLT2i, ICD/CRT-D); ACS
(antiplatelet, troponin); AF (CHA₂DS₂-VASc, DOACs); aortic stenosis; cardiac tamponade;
HCM management.
4. Pulmonary & Critical Care – COPD GOLD staging; asthma GINA step therapy; PE
diagnosis (CTPA); sarcoidosis (Löfgren syndrome); IPF (honeycombing); NIPPV for COPD
exacerbation.
5. Gastroenterology & Hepatology – Cirrhosis complications (HE, ascites, SBP, HRS, HCC
screening); acute cholecystitis; peptic ulcer disease; variceal bleed management.
6. Infectious Disease – Infective endocarditis (3 sets of blood cultures before antibiotics);
sepsis bundle timing; TB (cavitary upper lobe); antibiotic stewardship.
7. Endocrinology & Metabolism – SGLT2i and GLP-1 RA indications; diabetic medication
updates; thyroid disorders; diabetes insipidus.
8. Subspecialty "Mini-Topics" – Allergy/Immunology, Dermatology, Psychiatry, Neurology,
Geriatrics (reliably catch candidates who focus only on "big 8" specialties) .
9. Image/Audio Identification – ECGs, heart murmurs, rashes, radiographs and
photomicrographs (blood films, Gram stains) . Common pitfall due to under-practice .
10. Study Strategy – Foundation pass (40–60 Qs/day all categories, Months 1–3); Targeted
drilling weak areas (Months 4–8); Mixed mocks with image/audio (Months 9–11);
Bookmark-only review in final month. MKSAP is gold standard .
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100 MCQ Questions with Rationales
1. A 58-year-old man with alcohol-associated cirrhosis has tense ascites and early satiety.
Diagnostic paracentesis shows SAAG 1.8 g/dL and neutrophils 80 cells/mcL. Creatinine is 0.9
mg/dL and sodium is 136 mEq/L. Which is the most appropriate management?
A) Nonselective beta blocker escalation
B) Empiric ceftriaxone for spontaneous bacterial peritonitis
C) TIPS as first procedure
D) Large-volume paracentesis with albumin replacement
E) Fluid restriction without paracentesis
Correct Answer: D
Rationale: Tense ascites causing early satiety warrants large-volume paracentesis. SAAG >1.1
indicates portal hypertension. Neutrophils <250 rules out SBP, so antibiotics are not indicated .
This scenario tests cirrhosis complications management, a high-yield area.
2. A 72-year-old woman with heart failure with reduced ejection fraction (EF 30%) has a QRS
of 152 ms and LBBB on ECG. NYHA class III despite optimal medical therapy. What is the most
appropriate next step?
A) Increase diuretic dose
B) Refer for cardiac resynchronization therapy (CRT-D)
C) Start an SGLT2 inhibitor
D) Refer for coronary artery bypass grafting
E) Add hydralazine and isosorbide dinitrate
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Correct Answer: B
Rationale: HFrEF with LBBB and QRS ≥150 ms is a Class I indication for CRT-D. Device therapy
reduces mortality and improves symptoms in patients with dyssynchronous ventricular
contraction .
3. A patient with acute chest pain has ECG showing ST-segment elevation in leads V1–V4.
Troponin is elevated. Which antiplatelet regimen is indicated?
A) Aspirin alone
B) Aspirin + clopidogrel (dual antiplatelet therapy)
C) Aspirin + warfarin
D) Clopidogrel alone
E) Ticagrelor alone
Correct Answer: B
Rationale: STEMI requires dual antiplatelet therapy (aspirin + P2Y12 inhibitor) to prevent stent
thrombosis and recurrent events. DAPT is recommended for at least 12 months after ACS .
4. A 65-year-old with atrial fibrillation has CHA₂DS₂-VASc score of 4. Which anticoagulant is
preferred?
A) Aspirin 81 mg daily
B) Warfarin with INR target 2.0–3.0
C) Direct oral anticoagulant (DOAC)
D) Clopidogrel
E) No anticoagulation
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Correct Answer: C
Rationale: CHA₂DS₂-VASc ≥2 in men or ≥3 in women warrants anticoagulation. DOACs are
preferred over warfarin for nonvalvular AF due to reduced intracranial hemorrhage risk. Aspirin
is inadequate .
5. A 55-year-old with COPD has FEV1 55% predicted, FEV1/FVC <0.7, with frequent
exacerbations. GOLD stage and group classification?
A) GOLD 2, Group B
B) GOLD 2, Group E
C) GOLD 3, Group B
D) GOLD 3, Group E
E) GOLD 4, Group E
Correct Answer: B
Rationale: FEV1 50–79% predicted = GOLD 2. Frequent exacerbations = Group E. GOLD 2024
groups (A, B, E) incorporate exacerbation history; previous ABCD system has been updated.
6. A 30-year-old woman with erythema nodosum and bilateral hilar adenopathy on chest x-
ray. No treatment started. What is the most likely diagnosis and prognosis?
A) Sarcoidosis; often resolves spontaneously
B) Hodgkin lymphoma; requires chemotherapy
C) Tuberculosis; requires anti-TB therapy
D) Sarcoidosis; requires high-dose corticosteroids
E) Löfgren syndrome; requires immunosuppression